‘My special time’: Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal–infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face‐to‐face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, ‘my special time’ and three sub‐themes, ‘there is someone out there for me’, ‘it wasn't just a job’ and ‘swimming or stranded: feelings about leaving the service’, were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self‐determination in all therapeutic processes, including discharge, if recovery and self‐efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.     

Constructions and experiences of sexual health among young,heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified ‘purity versus corruption’ as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes ‘maintaining ignorance and naivety’, ‘remaining virginal’, ‘sex segregation’ and ‘the fallen woman’ capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.     

Re-framing microbicide acceptability: findings from the MDP301 trial

Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic (‘insider’) perspective or attempt to understand how microbicides fit into the broader context of women's and men's everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Women's experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on women's practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of women's and men's sexuality and sexual health.     

Breast cancer diagnosis: biographical disruption,emotional experiences and strategic management in Thai women with breast cancer

In this article we draw on Bury's theory of biographical disruption to discuss the meanings of, and emotional experiences related to, being diagnosed with breast cancer among southern Thai women. Qualitative methods, including in‐depth interviewing and drawing methods, were used to collect data from 20 women with breast cancer. The women perceived breast cancer to be a rhok raai; an evil or dread disease. They believed that breast cancer would lead to death. The disruption in their biography occurred when they detected abnormalities indicating breast cancer. The women's narratives revealed their chaotic lives upon this diagnosis and the news precipitated in them shock, fear, anxiety and loss of hope. Although they experienced chaos and disruption, the women cultivated strategies that helped them cope with their experiences by accepting their fate and adhering to Buddhist beliefs and practices. Through their narratives of biographical disruption, the women in our study offer healthcare providers knowledge that could lead to an appreciation of their needs and concerns. This knowledge is crucial for health professionals who wish to provide emotional support to women who have been diagnosed with breast cancer in Thailand and elsewhere.     

Women's decision making about whether or not to use breast cancer chemoprevention

BACKGROUND: Minimal research is available that examines how women at high risk for breast cancer make choices about chemoprevention. We examined how women decide whether to use chemoprevention within the Study of Tamoxifen and Raloxifene (STAR), a non-placebo arm prevention trial. DESIGN: We used in-depth, semi-structured interviews and qualitative analysis. We interviewed 28 participants who chose to take chemoprevention and 23 STAR eligible women who declined participation and chemoprevention. RESULTS: Most participants perceived themselves at heightened risk for and anxious about developing breast cancer and believed taking either trial medication was a reasonable way to reduce risk. More than half of non-participants did not perceive themselves at heightened risk for and felt little anxiety about breast cancer. More than half of non-participants felt at greater risk for developing other diseases. CONCLUSIONS: While breast cancer risk can be calculated with a fair degree of accuracy, its impact on women's choices about chemoprevention is likely best assessed in tandem with women's feelings about developing breast cancer, whether within the context of a clinical trial or not.     

Women's Experiences With Mammography Screening Through 6 Years of Participation—A Longitudinal Qualitative Study

In this article we explore women's experiences with 6 years of mammography screening. Regular and repeated mammography screening is promoted as an important tool for disease prevention among women worldwide. The purpose of the present study was to explore how continued participation in screening influences how women perceive screening and breast cancer. We carried out focus groups with 24 screening participants in 2003 and 2009. Our analysis highlights that while women were excited about the examination in 2003, it was perceived as routine in 2009. Waiting for the results became easier over the years, while stress related to receiving the results letter did not diminish. Knowledge of risk factors for breast cancer did not change. Personal risk assessment remained low, though high incidence of cancer among acquaintances suggested high risk for breast cancer among women in general. Analysis of participant experiences suggests that continuous participation in screening has led surveillance medicine to become a part of ordinary life.     

Infant feeding in risk society

A large percentage of British women, in common with women in other Western countries, feed their young babies formula milk. The paper reports some findings of a study of infant feeding that focussed on women's experiences of feeding their babies this way. Data about this issue were collected through detailed, qualitative face to face interviews with 33 mothers and through telephone interviews using a structured questionnaire with 503 mothers. The study found overall that mother's accounts of feeding babies formula milk draw attention to contradictions and tensions in motherhood and mothering. Formula feeding is predominantly experienced by mothers as ‘easy,’ enabling them to address a wide range of demands and difficulties that mothering a small baby poses for them. At the same time, mothers demonstrate awareness of the socio-cultural construction of the ‘moral mother’ as the mother who minimizes and avoids risk, and so does not use formula milk for infant feeding. How women react to this tension between ‘real life’ and ‘doing what is healthy’ varies, but the study reported here found a large minority of women experience manifestly difficult and debilitating feelings as they attempt to reconcile a pragmatic wish or need to formula feed with dominant constructions of the ‘moral mother.’ By detailing women's accounts of this aspect of motherhood, the paper contributes to sociological investigation of everyday experiences of risk society. To contextualize this discussion, a brief account of the relationship between eating, feeding babies and risk society is also offered.     

Cervical cancer narratives: invoking ‘God's will’ to re-appropriate reproductive rights in present-day Romania

Drawing from ethnographic fieldwork in contemporary Southern Romania, this paper scrutinises local moralities governing some women's refusal to enrol in free reproductive healthcare initiatives targeting cervical cancer through primary and secondary prevention (human papillomavirus [HPV] vaccination and Papanicolaou [Pap] testing, respectively). Women backed up their rejection of participation in official reproductive care programmes by mentioning ‘God's will’ as the ultimate trigger of cervical cancer. They withheld their own and their daughters' bodies from biomedical intervention and used discursive references to divine logic to imbue their refusal with moral legitimacy. However, ‘God's will’ is not a mere rhetorical device, since it has a correlate in many of these women's embodied reproductive experiences. As this paper argues, religious narratives, far from stripping ordinary citizens of their reproductive choices, constitute the medium through which they display individual agency. In fact, invoking ‘God's will’ empowers Romanian women to challenge state control and it enables them to re-appropriate their bodies by making a counter-intuitive, yet bold, choice.     

Blurring, moving and broken boundaries: men's encounters with the pregnant body

Abstract This paper draws on the findings of a longitudinal ethnographic study of men's transition to fatherhood, conducted in the United Kingdom (UK). It is concerned with their encounters with the pregnant and labouring body. Until relatively recently there has been surprisingly little work, either theoretical or empirical, on the experience of pregnant embodiment. Work in the last decade has indicated that women's experience of ‘being‐with‐child’, their experience of living in and being a pregnant body, can be an ambivalent affair, as some find disconcerting the experience of simultaneously being self and yet Other. If women, who possess the embodied and therefore privileged knowledge of pregnancy, can feel ambivalence, perhaps the case for expectant men is more so. This paper draws on interviews with men making the transition to fatherhood and analyses their experiences of and relation to the pregnant and labouring body. The theoretical analysis of their empirical accounts explores in particular the blurring, moving and broken boundaries of the pregnant and labouring body and how these changing body boundaries can challenge the taken‐ for‐granted assumption that bodies should always be contained, strong and firm. The implications of men's encounters with this ‘differently bounded’ body are examined.     

A narrative analysis of the birth stories of early‐age mothers

The telling of birth stories (i.e. stories that describe women's experiences of giving birth) is a common and important social practice. Whereas most research on birth narratives reflects the stories of middle‐class, ‘adult’ women, we examine how the birth stories told by early‐age mothers interconnect with broader narratives regarding social stigma and childbearing at ‘too early’ an age. Drawing on narrative theory, we analyse in‐depth interviews with 81 mothers (ages 15–24 years) conducted in Greater Vancouver and Prince George, Canada, in 2014–15. Their accounts of giving birth reveal the central importance of birth narratives in their identity formation as young mothers. Participants’ narratives illuminated the complex interactions among identity formation, social expectations, and negotiations of social and physical spaces as they narrated their experiences of labour and birth. Through the use of narrative inquiry, we examine the ways in which re‐telling the experience of giving birth serves to situate young mothers in relation to their past and future selves. These personal stories are also told in relation to a meta‐narrative regarding social stigma faced by ‘teenage’ mothers, as well as the public's ‘gaze’ on motherhood in general – even within the labour and delivery room.     

The baby and the bath water: disabled women and motherhood in social context

The aim of this paper is to explore key dimensions of the reproductive experiences of disabled women who are, or who are thinking about becoming, mothers. The paper reports a qualitative study which involved semi-structured interviews with 17 disabled women who were contemplating childbearing, or were pregnant, and/or had young children. The interpretation of these women's experiences is situated with reference to current debates on the meaning and nature of disability, and draws attention to the ways in which these experiences can be understood as manifestations of disablism. More specifically, the paper considers three themes which emerged in the data analysis: the women's engagement with the medical ‘risk’ discourse; the pressure felt by disabled women to demonstrate that they are, or could be, ‘good enough mothers’; and their experiences of receiving unhelpful ‘help’ from health and social care workers.     

Gender,self and pleasure: young women's discourse on masturbation in contemporary Shanghai

This study examines views and experiences of young Shanghai women with respect to masturbation. Through in-depth interviews with forty young women in Shanghai aged 22 to 39 from May 2004 to July 2007, the study explores women's understandings of masturbation, their desires and their lives as modern Chinese women. The focus of the analysis is on how women talk about their masturbation experiences and make sense of their experiences in the context of their sexual relationships and lifestyle choices. By analysing women's narratives about masturbation, the paper suggests that women's self-articulation is actually an engagement in self-image construction. The strategies they use to position themselves in relation to different social discourses on masturbation, how they describe and perform the acts and how they articulate their experiences of masturbation are examined to illustrate how young women in Shanghai perform gender and sexual intimacies in a fast changing city.     

Women's experiences of care after stillbirth and obstetric fistula: A phenomenological study in Kenya

Background

Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula.

Aim

To explore the lived experiences of women following stillbirth and fistula.

Methods

Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach.

Results

Three main themes summarised participants' experiences: ‘Treated like an alien’ reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in ‘Shattered dreams’. The impact of beliefs and practices of women and those around them were encapsulated in ‘It was not written on my forehead’.

Conclusion

The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences.

Patient or Public Contribution

A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant-facing materials and confirmation of findings.     

Why do women seek ultrasound scans from commercial providers during pregnancy?

The commercial availability of ultrasound scans for pregnant women has been controversial yet little is known about why women make use of such services. This article reports on semi‐structured interviews with women in the UK who have booked a commercial scan, focusing on the reasons women gave for booking commercially provided ultrasound during a low‐risk pregnancy. Participants’ reasons for booking a scan are presented in five categories: finding out the sex of the foetus; reassurance; seeing the baby; acquiring keepsakes and facilitating bonding. Our analysis demonstrates that women's reasons for booking commercial scans are often multiple and are shaped by experiences of antenatal care as well as powerful cultural discourses related to ‘good’ parenting and the use of technology in pregnancy. Sociological and public debate about the availability of commercial ultrasound and its social and personal impacts should consider the wider sociocultural context that structures women's choices to make use of such services.     

Sex and the ‘recently single’: perceptions of sexuality and HIV risk among mature women and primary care physicians

Primary care physicians may mistakenly conclude that sexual issues are unimportant to divorced or widowed mature women, based on age and gender biases. Although research suggests that many single mature women are sexually active, physicians are often reluctant to discuss sexual matters with them. Structured and open‐ended interviews explored perceptions regarding mature women's sexuality and HIV‐related risk for patient‐physician communication among 44 ‘recently single’ mature women aged 45–68 and 31 primary care physicians. Age and ethnic group comparisons with the mature women suggest that younger and African‐American women reported higher HIV and STI risk perception than older and White women. Many mature women (64%) believed that they were at‐risk for HIV and STIs, whereas physicians considered younger patients most at‐risk and that risk declined with patients' advancing age and with female status. Mature women and physicians had different expectations regarding initiation of clinical sexual health discussions, with 44% of the mature women placing the onus of responsibility on the patient, whereas 74% of physicians believed it was the role of both doctors and patients to bring up these topics. The findings are instructive to primary care physicians and healthcare policy makers, indicating that sexual health issues are relevant to mature women's continued health and well‐being.     

What help do young women want in their efforts to control their weight? Implications for program development

The aim of this study was to examine women's views on the usefulness of various types of information and practical sessions on weight control, their preferences for program delivery, and likelihood of participation. Cross‐sectional survey of 462 women aged 18–33 years randomly selected from the community was conducted. We examined the perceived usefulness of various types of information and practical classes on weight control; preferred mode of delivery; willingness to participate. Among the women 82% were interested in trying to lose or control weight. Information on weight control was considered to be more useful than practical sessions. Information about meal planning, cooking and low‐fat recipes and how to manage stress was considered most useful. Fifty‐eight per cent of women reported they would prefer to participate in an individual face‐to‐face program delivered by a health professional. Thirty‐one per cent of women reported it was very likely that they would participate in a program if it included the sort of things they considered useful and was offered in the way they preferred; a further 35% felt it ‘likely’. It appears that health professional‐delivered, individual, information‐based programs appear most popular among this target group. Tailoring the content and delivery mode of weight management programs to young women's preferences may enhance program participation.     

Access and utilisation of social and health services as a social determinant of health: the case of undocumented Latin American immigrant women working in Lleida (Catalonia,Spain)

Although Spain has social and healthcare systems based on universal coverage, little is known about how undocumented immigrant women access and utilise them. This is particularly true in the case of Latin Americans who are overrepresented in the informal labour market, taking on traditionally female roles of caregivers and cleaners in private homes. This study describes access and utilisation of social and healthcare services by undocumented Latin American women working and living in rural and urban areas, and the barriers these women may face. An exploratory qualitative study was designed with 12 in‐depth interviews with Latin American women living and working in three different settings: an urban city, a rural city and rural villages in the Pyrenees. Interviews were recorded, transcribed and analysed, yielding four key themes: health is a tool for work which worsens due to precarious working conditions; lack of legal status traps Latin American women in precarious jobs; lack of access to and use of social services; and limited access to and use of healthcare services. While residing and working in different areas of the province impacted the utilisation of services, working conditions was the main barrier experienced by the participants. In conclusion, decent working conditions are the key to ensuring undocumented immigrant women's right to social and healthcare. To create a pathway to immigrant women's health promotion, the ‘trap of illegality’ should be challenged and the impact of being considered ‘illegal’ should be considered as a social determinant of health, even where the right to access services is legal.     

Between stigma and pink positivity: women's perceptions of social interactions during and after breast cancer treatment

This study explores women's perceptions of social interaction during and after their treatment for early stage breast cancer. An analysis of interviews with 24 women between 6 months and 29 years post‐diagnosis reveals that interactions can be influenced by conflicting public discourses surrounding breast cancer. For example, there is the continuing association of cancer with death and the resulting potential for a stigmatised identity. In contrast is the ultra‐positive discourse around cancer survivorship, with breast cancer in particular being associated with pink campaigning and a push towards positive thinking. Participants described managing conversations during treatment; sometimes playing down their private suffering and presenting a positive (public) image rather than risk alienating support. After treatment they were encouraged to move on and get back to ‘normal’. While other breast cancer patients and survivors were often good sources of support, there was also a danger of assuming that all experiences would be the same. We present data to illustrate that women often present public accounts that are driven by an expectation of positivity and fear of stigmatisation at all stages of breast cancer treatment and beyond.